Introduction
In the context of nursing education in Aotearoa New Zealand, first-year students like Aroha and Jane are introduced to essential concepts that underpin professional practice. This essay explores the application of professional communication, therapeutic relationships, and cultural safety within a clinical learning scenario involving a bed wash for Mrs. Bernadette Williams, a 55-year-old patient recovering from orthopaedic surgery. The scenario requires students to adhere to the AI2DET framework (Acknowledge, Identify, Duration, Explain, Enquire, Thank) while practising foundational skills in the Clinical Learning Suite.
The essay addresses key learning outcomes by defining differences between social, personal, and therapeutic relationships; describing the four phases of establishing a therapeutic relationship linked to the AI2DET framework and scenario; discussing how Aroha and Jane build a therapeutic relationship with reference to relevant Pou from the Nursing Council of New Zealand (NCNZ) Standards of Competence (2025); examining professional boundaries with examples of over- and under-involvement; and identifying applicable principles from the NCNZ Code of Conduct (2012). These elements are grounded in culturally safe practice, which emphasises recognising unique cultural identities and power imbalances in healthcare (Nursing Council of New Zealand, 2025).
By linking these concepts to the scenario, the essay demonstrates their relevance to patient-centred care, professional integrity, and legislative standards guiding nursing in Aotearoa New Zealand. This analysis highlights the importance of therapeutic interactions in fostering trust and effective care, particularly in vulnerable situations like post-surgical recovery (Wilson, 2018). Ultimately, it underscores how novice nurses can apply these principles to ensure safe, respectful, and competent practice.
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Differences Between Social, Personal, and Therapeutic Relationships
In nursing practice, understanding the distinctions between social, personal, and therapeutic relationships is crucial for maintaining professionalism and ensuring patient safety. Social relationships are typically informal, reciprocal, and based on mutual interests or shared social contexts, such as friendships or acquaintanceships formed in everyday life. They lack a defined purpose beyond social enjoyment and involve equal power dynamics, with no professional obligations (Arnold and Boggs, 2019). For instance, a casual conversation with a neighbour about weekend plans exemplifies a social interaction, where both parties contribute equally without structured goals.
Personal relationships, in contrast, are deeper and more intimate, often involving emotional bonds, trust, and long-term commitment, such as family ties or romantic partnerships. These relationships are characterised by reciprocity, where personal needs and emotions are shared mutually, and boundaries may be flexible based on individual comfort. However, in a nursing context, personal relationships can complicate care if they involve the nurse and patient outside professional settings, potentially leading to conflicts of interest (College of Nurses of Ontario, 2018). For example, a nurse caring for a family member might struggle to maintain objectivity, blurring personal emotions with clinical decisions.
Therapeutic relationships, however, are purposeful, patient-centred, and time-limited, designed specifically to meet the health needs of the patient within a professional framework. Unlike social or personal relationships, they are asymmetrical, with the nurse holding power and responsibility to facilitate healing, while prioritising the patient’s well-being over mutual satisfaction (Peplau, 1991). Boundaries are strictly maintained to prevent exploitation, and the focus is on therapeutic communication to build trust and promote recovery. In the scenario, Aroha and Jane’s interaction with Mrs. Williams during the bed wash must remain therapeutic, avoiding social chit-chat that could distract from care or personal disclosures that might undermine professionalism.
These differences are particularly relevant in Aotearoa New Zealand’s nursing practice, where cultural safety requires nurses to reflect on their own biases and power imbalances to avoid imposing personal or social norms on patients (Nursing Council of New Zealand, 2011). For Aroha and Jane, recognising these distinctions ensures they provide culturally safe, patient-focused care without crossing into inappropriate familiarity, which could violate professional standards. Indeed, therapeutic relationships enhance outcomes by fostering a safe space for vulnerability, such as addressing Mrs. Williams’ pain during the procedure, whereas social or personal elements might introduce bias or discomfort (Wilson, 2018). Therefore, nurses must consciously apply these boundaries to uphold ethical practice.
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The Four Phases of Establishing a Professional Therapeutic Relationship
Establishing a therapeutic relationship in nursing follows four distinct phases, originally outlined by Peplau (1991): pre-orientation, orientation, working, and termination. These phases provide a structured approach to building trust and achieving health goals, and they align closely with the AI2DET framework in the scenario involving Aroha and Jane’s bed wash for Mrs. Williams.
In the pre-orientation phase, the nurse prepares mentally and gathers information about the patient before interaction. This involves reviewing patient history, such as Mrs. Williams’ post-orthopaedic surgery status and leg pain, to anticipate needs and reduce anxiety. Linked to AI2DET, this phase corresponds to preparation for acknowledging and identifying oneself, ensuring the nurses are informed and ready to explain the procedure competently (Stein-Parbury, 2017). Aroha and Jane would review required readings and the lecturer’s demonstration, setting the foundation for a professional encounter.
The orientation phase begins the actual interaction, where rapport is established through introductions and goal-setting. Here, Aroha and Jane would acknowledge Mrs. Williams, identify themselves as students, state the duration of the bed wash (e.g., 20-30 minutes), explain the steps to gain consent, and enquire about concerns, directly applying AI2DET. This phase addresses initial anxieties, such as Mrs. Williams’ pain, by clarifying expectations and building trust, which is essential in a vulnerable setting like bed rest (Arnold and Boggs, 2019).
During the working phase, the relationship deepens as the nurse and patient collaborate on care. Aroha and Jane would perform the bed wash, incorporating therapeutic communication to monitor pain and adjust accordingly, while maintaining cultural sensitivity. This links to AI2DET’s enquiry element, allowing ongoing checks for questions, ensuring the procedure remains patient-centred and effective.
Finally, the termination phase concludes the interaction, summarising outcomes and planning next steps. Aroha and Jane would thank Mrs. Williams, check if she needs anything else, and ensure a smooth handover, reinforcing closure without abruptness (Peplau, 1991). In the scenario, this prevents feelings of abandonment, particularly important for a patient on bed rest.
Overall, these phases, integrated with AI2DET, guide Aroha and Jane in delivering structured, respectful care, enhancing patient satisfaction and safety in the Clinical Learning Suite.
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Building a Therapeutic Relationship with Mrs. Williams
Aroha and Jane can build a therapeutic relationship with Mrs. Williams by applying principles from the NCNZ Standards of Competence (2025), specifically Pou Two (Cultural Safety), descriptor 2.1; Pou Three (Whanaungatanga and Communication), descriptor 3.3; and Pou Five (Manaakitanga and People-Centred Care), descriptor 5.4. These Pou emphasise culturally safe, communicative, and relational practices tailored to the patient’s needs during the bed wash scenario.
Under Pou Two, descriptor 2.1, nurses must practise culturally safe care as determined by the recipient. Aroha and Jane would begin by recognising Mrs. Williams’ unique cultural identity, perhaps enquiring about preferences related to her background or privacy during the procedure. This involves self-reflection on their own cultural biases to avoid assumptions, ensuring the bed wash respects her dignity and autonomy, especially given her vulnerability post-surgery (Nursing Council of New Zealand, 2025). For example, if Mrs. Williams identifies with Māori whānau values, they might incorporate holistic considerations, fostering trust and safety.
Pou Three, descriptor 3.3, requires incorporating professional, therapeutic, and culturally appropriate communication. In the scenario, Aroha and Jane would use clear, empathetic language via the AI2DET framework, explaining steps in a way that honours cultural nuances, such as using te reo Māori terms if appropriate. This builds whanaungatanga (relationship-building) by actively listening to her pain concerns, adapting communication to be inclusive and respectful (Wilson, 2018).
Pou Five, descriptor 5.4, focuses on establishing, maintaining, and concluding safe therapeutic relationships. Aroha and Jane would initiate rapport through consent, maintain it by addressing needs during the wash, and conclude by thanking her, ensuring the interaction remains bounded and beneficial. This people-centred approach prioritises her comfort, promoting healing in a mana-enhancing way.
Together, these Pou guide Aroha and Jane in creating a relationship that is safe, reciprocal, and effective, aligning with Aotearoa New Zealand’s commitment to Te Tiriti o Waitangi principles. However, challenges like time constraints in practice could arise, requiring ongoing reflection to sustain cultural safety (Nursing Council of New Zealand, 2025).
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Professional Boundaries in Relation to the Scenario
Professional boundaries in nursing define the limits of the therapeutic relationship, ensuring interactions remain focused on patient needs while preventing harm from over- or under-involvement. In Aotearoa New Zealand, these are guided by the NCNZ Guidelines: Professional Boundaries (2012b), which emphasise maintaining a balance where the nurse’s power is used ethically. In the scenario, Aroha and Jane must navigate boundaries during the bed wash to provide safe, respectful care for Mrs. Williams, avoiding actions that could exploit her vulnerability.
Boundaries encompass emotional, physical, and communicative dimensions, requiring nurses to self-regulate and reflect on power dynamics (Nursing Council of New Zealand, 2012b). For instance, physical boundaries involve appropriate touch during procedures, while emotional ones prevent sharing personal issues. In the Clinical Learning Suite, Aroha and Jane should focus solely on therapeutic goals, using the AI2DET framework to structure interactions without unnecessary familiarity.
An example of over-involvement could occur if Aroha shares personal stories about her own surgery experiences to “comfort” Mrs. Williams, shifting focus from the patient to the nurse and blurring roles. This might create dependency or discomfort, violating boundaries by making the interaction too personal and potentially breaching confidentiality or cultural safety (Peternelj-Taylor and Yonge, 2003).
Conversely, under-involvement might happen if Jane rushes the procedure without enquiring about Mrs. Williams’ pain or concerns, appearing detached and failing to build rapport. This could leave the patient feeling undervalued, undermining trust and the therapeutic alliance, especially in a culturally diverse context where relational warmth is key (Nursing Council of New Zealand, 2012b).
Both examples highlight risks in the scenario: over-involvement erodes professionalism, while under-involvement neglects patient-centred care. Therefore, education on boundaries equips students like Aroha and Jane to recognise warning signs, such as emotional entanglement, and seek supervision, ensuring adherence to standards that protect all parties (College of Nurses of Ontario, 2018).
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Relevant Principles from the NCNZ Code of Conduct (2012)
The NCNZ Code of Conduct (2012a) outlines eight principles guiding ethical nursing practice in Aotearoa New Zealand, with several particularly relevant to Aroha and Jane’s interaction with Mrs. Williams in the bed wash scenario. These principles ensure professional, culturally safe care aligned with Te Tiriti o Waitangi.
Principle 1, respecting the dignity and individuality of health consumers, is central. Aroha and Jane must treat Mrs. Williams with respect, acknowledging her unique needs, such as pain management during the procedure, and gaining informed consent via AI2DET to uphold her autonomy (Nursing Council of New Zealand, 2012a).
Principle 2 emphasises establishing trust through honest communication. In the scenario, transparent explanations of the bed wash foster reliability, essential for a patient on bed rest who may feel vulnerable.
Principle 4, on maintaining professional boundaries, directly applies by requiring Aroha and Jane to keep interactions therapeutic, avoiding over-sharing that could compromise care.
Principle 7, relating to cultural safety, requires recognising power imbalances and practising in a way that affirms Mrs. Williams’ cultural identity. This integrates with Pou standards, ensuring the procedure is recipient-determined.
Principle 8, promoting justice and inclusiveness, ensures equitable care, addressing any biases in the students’ approach.
These principles integrate into the scenario by guiding student actions: for example, respecting dignity prevents under-involvement, while maintaining boundaries avoids over-involvement. Application demonstrates understanding of ethical practice, though challenges like inexperience may require lecturer support (Nursing Council of New Zealand, 2012a). Overall, they reinforce competent, safe nursing in diverse contexts.
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Conclusion
This essay has examined key aspects of professional nursing practice in Aotearoa New Zealand through the lens of Aroha and Jane’s clinical scenario. It defined distinctions between social, personal, and therapeutic relationships, highlighting their relevance to patient-centred care; described the four phases of therapeutic relationships linked to AI2DET; discussed building therapeutic alliances using NCNZ Pou; explored professional boundaries with examples; and identified pertinent Code of Conduct principles.
These elements underscore the importance of culturally safe, bounded interactions in fostering trust and effective care, particularly for vulnerable patients like Mrs. Williams. By applying these standards, novice nurses develop skills that align with legislative and ethical requirements, enhancing outcomes in diverse settings. However, ongoing reflection and education are essential to navigate complexities, such as cultural nuances or boundary challenges. Ultimately, this foundation prepares students for competent, compassionate practice that honours Te Tiriti principles and promotes health equity.
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References
- Arnold, E.C. and Boggs, K.U. (2019) Interpersonal relationships: Professional communication skills for nurses. 8th edn. Elsevier.
- College of Nurses of Ontario. (2018) Therapeutic nurse-client relationship. Toronto: College of Nurses of Ontario.
- Nursing Council of New Zealand. (2011) Guidelines for cultural safety, the Treaty of Waitangi and Maori health in nursing education and practice. Wellington: Nursing Council of New Zealand.
- Nursing Council of New Zealand. (2012a) Code of conduct for nurses. Wellington: Nursing Council of New Zealand.
- Nursing Council of New Zealand. (2012b) Guidelines: Professional boundaries. Wellington: Nursing Council of New Zealand.
- Nursing Council of New Zealand. (2025) Standards of competence for registered nurses. Wellington: Nursing Council of New Zealand.
- Peplau, H.E. (1991) Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. Springer Publishing Company.
- Peternelj-Taylor, C.A. and Yonge, O. (2003) ‘Exploring boundaries in the nurse-client relationship: Professional roles and responsibilities’, Perspectives in Psychiatric Care, 39(2), pp. 55-66.
- Stein-Parbury, J. (2017) Patient and person: Interpersonal skills in nursing. 6th edn. Elsevier.
- Wilson, D. (2018) ‘Cultural safety: A renewed approach in Aotearoa New Zealand’, Kai Tiaki Nursing New Zealand, 24(3), pp. 18-20.
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